Research Paper on Nurse Practitioner's Ethical & Legal Issues with Prescribing Medication

Introduction

Ethical and legal issues normally arise in nursing, especially during the prescription of medications to patients (Rosenthal & Burchum, 2017). The ethical implication on the pharmacist in this scenario is deciding if the practitioner nurse can be reported or not. It is unethical to disclose the type of medication prescribed to a patient. The major legal implication occurs when the nurse practitioner prescribes medication to her husband. It is illegal for the pharmacist to give narcotic drugs to patients without an appropriate prescription. According to California state laws, it is illegal for a nurse or any other health personnel to prescribe medications to a family member and a close friend (Rosenthal & Burchum, 2017). The prescriber may be fired for making a prescription to her husband. The main ethical implication on the patient includes addition and social irresponsibility due to the use of the narcotic drug. The patient may be arrested for taking inappropriately prescribed narcotic drugs.

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Strategies to Address Disclosure and Nondisclosure in the Scenario

Medical errors normally occur in nursing practices. Prescription normally results in a medical error that must be minimized at all cost (Rosenthal & Burchum, 2017). To address the issues related disclosure and nondisclosure in the scenario requires effective implementation of strategies. First, get the right medication for the patient to prevent both ethical and legal implications on all stakeholders. Food and Drug Authority (FDA) have established various approaches for ensuring that appropriate medications are prescribed to patients (Hughes, 2008). Also, the FDA contains legislations that necessitate barcodes on specific drug labels (Griebling, 2019). The barcodes will allow prescriber and pharmacist to apply a barcode scanning device to verify the identity of a drug (Hughes, 2008). Barcode scanning approach reduces the chances of making medical errors during the prescription process.

Secondly, the nurse should be assessed on her certification. In this case, a certified health practitioner is competent; therefore, reducing the risks of prescription errors. Licensing is an appropriate strategy that can be applied in deciding on disclosing the case (Whitelaw, 2017). For instance, prescription of Schedule III substances requires certification from the state's authority. Narcotic drugs are considered to be Schedule III substances; therefore, their prescription is regulated by California state laws (Whitelaw, 2017). According to Californian laws, prescription of Schedule III drugs to a patient in a different state (Whitelaw, 2017). Also, the prescription of Schedule III controlled drugs must be reported immediately to CURES (US Food and Drug Administration, 2011).

Lastly, out-of-state CIII prescriptions can be filled to conform to the patient's health and the need to use narcotic drugs (Whitelaw, 2017). According to section 1717 (d) of California Code of Regulations, oral and written forms of drug prescription to patients may be used to avoid medical errors (Whitelaw, 2017). Nondisclosure of this prescription in the scenario may also require the application of these strategies.

Two Strategies that Guide During Decision-Making in the Scenario

Effective decision making is important in reporting all medical errors that occur due to inappropriate prescription (Whitelaw, 2017). Various strategies have been developed by the American Nursing Association to help all advanced practice nurses in making effective decision. The first strategy is searching and evaluating other reported similar cases in California. Thorough research on other cases helps to make appropriate and informed decisions. Another strategy is reading the side effects of the prescribed narcotic drug on the patient to determine if the case will be reported or not (Griebling, 2019). If the side effects are adverse on the patient's health, I will disclose the case for appropriate management. I will not report the error because it is to unethical to disclose medications prescribed to the patient. However, I will provide a solution to the problem by identifying the correct drug that can be used in treatment. If the narcotic drug is necessary, I will employ out-of-state prescription approach as required by California state laws.

The Process of Writing Prescriptions and Strategies to Minimize Medical Errors

The process of writing a prescription involves various steps that must be followed to prevent medical errors. Clearly define and evaluates patient's problem, specify the therapeutic goals, choose the correct drug for therapy, consider non-pharmacological therapies, provide detailed information, warnings, and instructions, assess therapy on a regular basis, consider the cost of the selected drug for prescription, and use automated forms to of description to reduce possible medical errors (2019 American Geriatrics Society Beers Criteria, 2019).

Identify and implementing strategies for preventing medical is pivotal in minimizing the risks of incorrect prescription (US Food and Drug Administration, 2011). First, apply automation in detecting prescription errors. For example, creating standard spreadsheets and web-based forms help in revealing the pattern of error. Physician voluntary and participation are important because they contribute to positive outcomes of automation. Improving computer systems allow nurses to ensure correct prescription; therefore, serious legal issues that might result in loss of the job (Shah, 2011). Another strategy for minimizing medical errors is understanding abbreviations, dose designations, and symbols that can be misinterpreted during prescription (Wittich, Burkle, & Lanier, 2014). Understanding the list of abbreviations probe to misinterpretations is important in minimizing harmful medical errors.

References

Griebling, T. L. (2019). Re: American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The Journal of Urology, 202(3), 438-438. doi: 10.1111/jgs.15767

2019 American Geriatrics Society Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Steinman, M., Beizer, J., Brandt, N., ... & Flanagan, N. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15767

Hughes, R. G. (2008). Medication Administration Safety--Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21328757

Rosenthal, L., & Burchum, J. (2017). Lehne's Pharmacotherapeutics for Advanced Practice Providers-E-Book. Elsevier Health Sciences. Retrieved from: http://iaibojonegoro.com/wp-content/uploads/2019/06/Lehnes-Pharmacotherapeutics-for-Advanced-Practice-Providers.pdf

Shah, H. D. (2011). A case of look-alike medication errors. Indian journal of pharmacology, 43(4), 482. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153723/

US Food and Drug Administration. (2011). Strategies to reduce medication errors: working to improve medication safety. Silver Spring, MD: US FDA. Retrieved from:

Whitelaw, M. (2017). A Path to Peace in the US Drug War: Why California Should Implement the Portuguese Model for Drug Decriminalization. Loy. LA Int'l & Comp. L. Rev., 40, 81. Retrieved from: https://heinonline.org/HOL/LandingPage?handle=hein.journals/loyint40&div=6&id=&page=

Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2014). Medication errors: an overview for clinicians. In Mayo Clinic Proceedings (Vol. 89, No. 8, pp. 1116-1125). Elsevier. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S002561961400439X